Cross - Enterprise Screening Mammography - Workflow Definition (XSM-WD) White Paper for 2011/2012 presented to the RAD Technical Committee, Planning Committee, Mammography Arianna Cocchiglia, Francesca Vanzo, Luca Zalunardo December, 9th 2011

White Paper developing The work group started to draw up the draft version of the White Paper The main themes of the work are: description of the most common practices in mammography screening according to several workflows and conveying them in the Mammography Screening Task Diagram definition of the actors and transactions needed in this clinical process definition of a common structure for the Workflow Document

The Mammography Screening Task Diagram As known, this White Paper relies on of the ITI XDW profile by using the Workflow Document which manages and gathers the details necessary about the screening process and collects: Workflow and Tasks Information Input Document References Output Document References In order to enrich the Task Diagram, Input and Output Documents items have been included

The Mammography Screening Task Diagram TASK 1: RECRUITMENT Task 1  4 INPUT …….. OUTPUT - Invitation Letter If a woman misses her scheduled appointment OR OR TASK 2a: ADMISSION TASK 2b: ADMISSION INPUT - Previous Exams - Invitation Letter INPUT - Invitation Letter …………… OUTPUT - Images (KOS Document) - Anamnestic Document OUTPUT - “No admission” Document END TASK 3: EVALUATION 1 TASK 4: EVALUATION 2 INPUT - Images (KOS Document) - Anamnestic Document INPUT - Images (KOS Document) - Anamnestic Document OUTPUT - Report 1 OUTPUT - Report 2

The Mammography Screening Task Diagram TASK 5: CS EVALUATION INPUT - Report 1 - Report 2 OUTPUT - Response Report (--,++,+-) OR OR OR TASK 6a: END (--) TASK 6b: SECOND LEVEL (++) TASK 6c: EVALUATION 3 INPUT - Response Report INPUT - Response Report INPUT - Images (KOS Document) - Anamnestic Document OUTPUT - Letter to Patient END OUTPUT - Letter to Patient (“Alert”) Planning Document END OUTPUT - Report 3 TASK 7: RESPONSE OR INPUT - Report 1 - Report 2 - Report 3 OR OUTPUT - Response Report (+-+,+--) TASK 6a: END (+--) TASK 6b: SECOND LEVEL (+-+)

Actors and Transaction XSM–WD Diagram Complete Diagram

Actors and Transaction XSM–WD Diagram Complete Diagram XDS Lifecycle Management Tools coordinate Workflow Document updates

Actors and Transaction XSM–WD Transactions Optionality Content Consumer Registry Stored Query [ITI-18] R Retrieve Document Set-b [ITI-43] Content Creator Provide and Register Document Set-b [ITI-41] Content Updater Document Consumer Document Registry Register Document Set-b [ITI-42] R  Document Repository Provide and Register Document Set-b MTOM/XOP [RAD-68] Document Source XDW Specific Actors XDS Specific Actors

Actors and Transaction XSM–WD Transactions Optionality Image Display Query Images [RAD-14]   Retrieve Images [RAD-16] Query Key Image Note [RAD-30] Retrieve Key Image Note [RAD-31] Query Evidence Documents [RAD-44] Retrieve Evidence Documents [RAD-45] Image Manager / Image Archive Image Availability Query [RAD-11] Imaging Specific Actors 1/2

Actors and Transaction XSM–WD Transactions Optionality Imaging Document Consumer Retrieve Images [RAD-16] R Retrieve Presentation States [RAD-17] Retrieve Reports [RAD-27] Retrieve Key Image Note [RAD-31] Retrieve Evidence Documents [RAD-45] WADO Retrieve [RAD-55] Registry Stored Query [ITI-18] Retrieve Document Set-b [ITI-43] Imaging Document Source Provide & Register Imaging Document Set MTOM/XOP [RAD-68] Retrieve Imaging Document Set [RAD-69] Imaging Specific Actors 2/2

Actors and Transaction XSM–WD Transactions Optionality Order Filler Procedure Scheduled [RAD-4]   Procedure Update [RAD-13] Performed Work Status Update [RAD-42] Report Creator / Report Reader Workitem Claimed [RAD-38] Workitem PPS in Progress [RAD-39] Workitem PPS Completed [RAD-40] Workitem Completed [RAD-41] Query Reporting Worklist [RAD-46] Report Manager (optionally grouped with a Report Repository) Image Availability Query [RAD-11] Other Actors

XSM–WD in the XDS environment The complete Actor and Transactions Digram shows several transactions and groupable actors Since the Workflow Document is meant to be constantly updated with the information conveyed by the XDS transactions, we will consider the XSM-WD Workflow Document from this point of view

Workflow Document: Creation and update The Content Creator constitutes the first version of the Workflow Document The Content Updater modifies and adds new data based on the tracking of the screening process The Content Consumer retrieves the Workflow Document Actors Transactions In XDS context grouped with Content Consumer Registry Stored Query [ITI-18] XDS Document Consumer Retrieve Document Set-b [ITI-43] Content Creator Provide and Register Document Set-b [ITI-41] XDS Document Source (Folder Management Options) Content Updater XDS Document Source (Document Replacement Option and Folder Management Options) or a XDS Document Consumer

Workflow Document: Creation The Content Creator constitutes the first version of a Workflow Document and places it into a new Workflow Context Folder (stored in the Document Repository) which will be a fixed reference for the Workflow Document. This actor shall: Create a New Workflow Context Folder Generate the First Version of the XSM-WD Workflow Document with the Description information, the Recruitment Task setting as “Completed” the Task’s status including the Input/Output Document References Submit the Workflow Document to the Folder stored in the Document Repository Actors Transactions In XDS context grouped with Content Creator Provide and Register Document Set-b [ITI-41] XDS Document Source (Folder Management Options)

Workflow Document: Update The Content Updater modifies and adds new data based on the tracking of the screening process and provides it to the Document Repository and Registry by a Replace. The Content Updater shall: Get the only “Approved” version of the Workflow Document in the Folder Update XSM-WD Workflow Document Description elements Include the new Task, added to the content of the latest Workflow Document version, with its own Input/Output Document References Save all changes in a new Workflow Document, setting as “Deprecated” the last one and as “Approved” the current version) Submit the updated Workflow Document to the Folder (stored in the Document Repository) Actors Transactions In XDS context grouped with Content Updater Registry Stored Query [ITI-18] XDS Document Source (Document Replacement Option and Folder Management Options) or a XDS Document Consumer Retrieve Document Set-b [ITI-43]

Workflow Document: Update Into the Folder there will be only one Workflow Document with the “Approved” status. All the previous ones are located into the same Folder will have a “Deprecated” status The case with more Content Updaters which modify and add new data using a common latest version of the Workflow Document would succeed only for the first Content Updater who submits it. Infact the other(s) would submit the Workflow Document with the documentUniqueID of a “Deprecated” Workflow Document and this can not be accepted Example Task 3-4: The second radiologist Content Consumer should always refer to the Evaluation 1 Worflow Document to avoid errors: The second radiologist will not see the screening Images on his/her worklist until the first one will have finished his/her evaluation Another etrieve of the “actual” Workflow Document and update of it only at the end of each Evaluation (for these two Tasks)

Workflow Document: Retrieve The Content Consumer retrieves the Workflow Document, obtains informations from it,… This actor should retrieve the latest version which coincides with the unique “Approved” version Input/Output Document references for each Task include: XDSDocumentEntry.uniqueId homeCommunityId Possible queries: Find the Workflow Folder for a Patient Get the Workflow Folder in which a particular Workflow Document is stored Get one or more document referenced in a Workflow Document … Actors Transactions In XDS context grouped with Content Consumer Registry Stored Query [ITI-18] XDS Document Consumer Retrieve Document Set-b [ITI-43]

XSM–WD Workflow Document The XDM-WD Workflow Document cutomization complies the XDW XML Schema which includes elements from the following standards: HL7 CDA OASIS WS-Human Task The four part Document composition: See XDW Profile for the detailed description of all WD elements Elements Standard/Profile id CDA Standard effectiveTime confidentialityCode languageCode title patient HL7 R-MIM Standard author workflowInstanceId ITI XDW Profile WorkflowDocumentInstanceNumber workflowStatus workflowDefinitionReference TaskList OASIS WS-HumanTask Standard

XSM–WD Workflow Document Screening Mammography Workflow Document Workflow Document Information: id : documentId title : « Screening Mammography Workflow Document » effectiveTime : … confidentialityCode : … languageCode : … patient : Jane Doe  author : Dr.Kris  workflowIstanceId : workflowDocumentSequenceNumber : « 3 » workflowStatus : « OPEN » workflowDefinitionReference : to workflow definition template (urn: OID:…) XDWdocumentHistory : …  XSM–WD Workflow Document The XSM-WD Workflow Document at Task 3 “Evaluation 1”: TASK 3: EVALUATION 1 INPUT - images (KOS Document) - anamnestic doc TaskList OUTPUT - Report 1 XDWTask taskData Name : Recruitment id : Status : Completed Date/time : Input : Lists of eligible women Output : Recruitment Letter actualOwner : Dr.Smith … The main Workflow Document Informations are located in the first three part of the structure Some elements are updated upon on the specific Task: author, workflowDocumentSequenceNumber workflowStatus,… The fourth part is composed by the list of the actual and the previous Tasks XSM-WD Workflow Document Workflow Document Information: id : documentId title : « Screening Mammography Workflow Document » effectiveTime : … confidentialityCode : … languageCode : … patient : Jane Doe  author : Dr.Kris  workflowIstanceID : workflowDocumentSequenceNumber : « 3 » workflowStatus : « OPEN » workflowDefinitionReference : to workflow definition template (urn: OID:…) XDWdocumentHistory : …  taskEventHistory  XDWTask taskData Name : Admission id : Status : Completed Date/time : Input : Invitation Letter, Previous exams Output : KOS Document, Anamnestic Document actualOwner : Dr. White … TaskList  taskEventHistory  XDWTask taskData Name : Evaluation 1 id : Status : Completed Date/time : Input : KOS Document, Anamnestic Document Output : Report 1 actualOwner : Dr. Kris … taskEventHistory 

XSM–WD Workflow Document The XSM-WD Workflow Document at Task 3 “Evaluation 1”: TASK 3: EVALUATION 1 INPUT - images (KOS Document) - anamnestic doc XDWTask OUTPUT - Report 1 OUTPUT - Report 1 taskData Name : Recruitment id : Status : COMPLETED Date/time : Input : Lists of eligible women Output : Recruitment Letter actualOwner : Dr.Smith … The taskList element includes all generated Tasks items taskEventHistory  The last Task’s actualOwner represents the author for the general information of the Workflow Document XDWTask XDWTask taskData Name : Evaluation 1 id : Status : COMPLETED Date/time : Input : KOS Document, Anamnestic Document Output : Report 1 actualOwner : Dr. Kris … taskData Name : Admission id : Status : COMPLETED Date/time : Input : Invitation Letter, Previous exams Output : KOS Document, Anamnestic Document actualOwner : Dr. White … taskEventHistory  taskEventHistory 

Example: taskData Element in XSM-DW <ns3:taskData> <ns2:taskDetails> <ns2:id>3</ns2:id> <ns2:taskType>Requested</ns2:taskType> <ns2:name>Evaluation 1</ns2:name> <ns2:status>COMPLETED</ns2:status> <ns2:createdTime>YYYY-MM-DDTHH:MM:SS.0Z</ns2:createdTime> <ns2:lastModifiedTime>YYYY-MM-DDTHH:MM:SS.0Z</ns2:lastModifiedTime> <ns2:renderingMethodExists>false</ns2:renderingMethodExists> </ns2:taskDetails> <ns2:description></ns2:description> <ns2:input> <ns2:part name="xdw"> <reference uid="urn:oid:1.2.3.4.4.3.2.2.X"/> <!– KOS Document --> </ns2:part> <reference uid="urn:oid:1.2.3.4.4.3.2.2.Y"/> <!– Anamnestic Document--> </ns2:input> <ns2:output> <reference uid="urn:oid:1.2.3.4.4.4"/> <!– Report 1 --> </ns2:output> </ns3:taskData> XDWTask taskData Name : Evaluation 1 id : Status : COMPLETED Date/time : Input : KOS Document, Anamnestic Document Output : Report 1 actualOwner : Dr. Kris … taskEventHistory  Work in progress: The entire customization on the Screening Mammography Workflow Document